CPT code 42227: Palate lengthening, with muscle repositioning2026 Medicare rate & RVUs

Medicare pays $774.90 for 42227 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42227 covers

This operation lengthens the palate while repositioning palatal muscle, generally to improve velopharyngeal function when the palate is too short or does not close adequately. It may be performed as secondary surgery for a patient with a history of cleft palate repair. Plastic and craniofacial surgeons, oral and maxillofacial surgeons, or otolaryngologists may perform the procedure in an operating room.

Report 42227 when the operative record supports palate lengthening with muscle repositioning, rather than a different palatal repair or lengthening procedure. Document the indication, prior palate history when relevant, and the specific surgical work performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral adjustment is inappropriate for this palatal procedure. An assistant at surgery may be paid; co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 42227 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42227 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 42227 rate is calculated

Each of 42227’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 42227

42227 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

42227 compared with similar codes

How to choose

42226Palate lengtheningIsland flap technique

Both codes concern palate lengthening. Use 42227 when muscle repositioning is part of the documented operation; distinguish 42226 by its specific operative service.

42225Cleft palate repairSecondary lengthening procedure

42225 represents a different secondary palatoplasty service. Choose 42227 when the documented work is palate lengthening with muscle repositioning.

42200Cleft palate repairSoft and/or hard palate

42200 is used for cleft palate reconstruction, while 42227 identifies palate lengthening with muscle repositioning. Base selection on the procedure actually performed.

Codes related to 42227

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates